Polypharmacy or just the right treatment for the old patients with chronic heart failure

Introduction: For the very old patients with congestive heart failure the use of combinations of drugs can easily lead to a sort of „evidence-based” polypragmasie. Methods: We analyzed a lot of 125 patients older than 85 years (mean 87.43 +/- 2.54 years, range 85 – 99 years), 52.6% male, enrolled consecutively between January 2011 – December 2012, diagnosed with congestive heart failure. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure have been issued in 2012, which allowed us to compare changes in the number of the administered drug and of the regimens between the subgroup treated in 2011 (lot A, n = 60) vs 2012 (lot B, n = 65). Results: The group included patients diagnosed mainly with ischemic dilated cardiomyopathy (57/45.6%), alcoholic cardiomyopathy (4/3.2%), mixed (26/20.8%), hypertensive cardiopathy (31/30.4%), in NYHA class II (61/48.8%), class III (55/44%) and class IV (9/7.2%), with length of hospitalization of 8,10 days, the rate of rehospitalization 6,4% and the death rate 10,4%. Number of drugs taken was 5,56 in group A vs 6,31 in group B, by increasing the number of patients who received spironolactone, digoxin, ARBs, acenocoumarol and trimetazidine whereas the proportion of patients who received aspirin decreased. There was no difference between group A and B in terms of length of stay, death rate and readmission rate. Conclusions: Increasing the number of drugs given to patients over 85 years has not proven to be more effective in terms of reducing length of stay, the rate of death and rehospitalization. The very old patient exposed to polypragmasie should use only the drugs with proved efficiency at this age.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)